We don't have CT scan at my Hospital. Ultrasound is not a good test to find liver mets. We always do laparoscopy before gastrectomy, to help us to tumor staging. If we find liver mets, ascites, peritoneal implantation, we do not perform gastrectomy or any other procedure, and we avoid laparotomy that has a higher morbidity.

I thought ultrasound was a good test to find liver mets. Please note that I am not advocating ultrasound before gastrectomy for gastric cancer to look for liver mets--just indicating my impression that ultrasound would show liver mets.

I guess I'm on the threshold of disputing the claim that laparotomy is the most sensitive tool for diagnosing intrahepatic mets. Although I have no personal experience with this, I understand that intraoperative laparoscopic ultrasound , in the absence of any still to be discovered radio-immuno-bullet, is the most sensitive.

I mentioned that I did a biopsy of a celiac lymph node. The patient had already an endoscopic biopsy which showed moderately differentiated adenocarcinoma. One for-surgeons.com member criticized my repeating the biopsy. The pathology report for the node biopsy showed poorly differentiated carcinoma; they even had to do histochemical stains to verify that it was adenocarcinoma. I don't know enough about oncology to speculate as to whether this will change his treatment, but I think this information is interesting and worth having.

This information may be interesting for you ,but it is NOT worth having as it will not change any line of management.

Endoscopic punch biopsies of moderately differentiated adenocarcinoma does not mean in any way that the whole tumor is the same,it is very common to find other areas of poorly differentiated adenocarcinoma in the same tumor,to judge the hitologic differentiation of the tumor you have to get the stomach out first and then examine the whole resected specimen,if you find areas of poor differentiation this will be merely an index of prognosis and have no influence on any line of management.

Lymph node metastases is very common poorly differentiated either due to change in the biological behaviour of the metastasized cells or due to small foci ,of poorly differentiated cells in a moderate or well differentiated primary,which tend to metastasize first.